EMS SYSTEMS

Topics History of EMS Components of an EMS System National Groups and Associations

Today we will look at the History of EMS

History

History (cont’d) Where do we start when looking at the history of EMS? 25 years ago? 50 years ago? Further back still?

The History of EMS and EMS systems have developed from the traditional and scientific beliefs of many cultures.

Ancient Times First “protocols” established in Mesopotamia. Evidence of medications, patient assessment techniques, and bandages. During the 15th century Crusades, special tents for the wounded called ‘ambulancias’ were prepared by King Ferdinand and Queen Isabelle of Spain. From earliest times, people have required a means of transporting their wounded and sick. The first wounded were probably carried in a hammock strung between two poles. Other unique conveyances included human dhooleys which were used in India; wicker cradles called mule panniers; and Egyptian camel litters. The Mojave Indians devised a litter comprised of a sheet of canvas between two poles carried on the shoulders of two men.

18th and 19th Centuries First efforts of field care developed by one of Napoleon’s surgeons, Barron Domenic-Jean Larrey, during the Austrian/Prussian conflicts in 1792. Even the American Civil War forced changes and advancements onto the medical system. Triage, a method of sorting patients by severity, was also developed during this time. mobile ambulances -- light-weight, two wheeled vehicles which stayed with the troops and allowed surgeons to work on the battlefield, an idea he later refined for Napoleon during the General’s Italian campaign American Civil War when ambulances were too few, often late, and driven by civilian drunkards and thieves. A physician named Jonathan Letterman reorganized the field medical service to provide an effective ambulance service for the evacuation of battle casualties 1864, an act was passed in Congress entitled “An Act to Establish a Uniform System of Ambulances in the Armies of the United States,” which spelled out who was responsible for each phase of the ambulance system 1864 Convention in Geneva, an agreement was made by several European countries to recognize the neutrality of hospitals, of the sick and wounded, of all persons connected with relief service, and the adoption of a protective sign or badge. The RED CROSS. In America, a similar organization had been functioning during the Civil War. The Sanitary Commission, which 20 years later became the American Red Cross, was brought into being in large part due to the efforts of Clara Barton Ambulance service has not been confined to ground units. During the Civil War, train ambulances and steam boat hospitals were used, and street car/trolley ambulances were popular in some cities in the late 1800s Baron Larrey developed all of the precepts of emergency medical care used today: 1) rapid access to the patient by trained personnel, 2) field treatment and stabilization, and 3) rapid transportation back to the medical facility, while 4) providing medical care en route. Although removal of the wounded and dead from the battlefields has existed in some form since early Greek and Roman times, Larrey can still be considered the "father of emergency medical services."

20th Century World Wars I and II and the Vietnam and Korean conflicts resulted in great advances in patient care delivery systems including transportation and patient care procedures. Buses and taxies became ambulances and the soldiers in Korea saw the first Medevac.

1966-US The National Highway Safety Act established the Department of Transportation which provided grants for EMS. US only

1969-US The EMT-Ambulance program was made public. The first paramedic curriculum followed in 1977. US again

White House issues $9 million in EMS grants. Alberta had first paramedic program. No such funding was available in Canada at this time Alberta program was 6 months and modeled after LA paramedic program by Dr. Ron Stewart.

1972- The Department of Health, Education & Welfare funded initiatives to develop regional systems. Kingston Paramedic Course Kingston course graduated one class of paramedics but there was no place for them to go and work.

EMS Systems Act of 1973 Provided funding for a series of trauma projects. $300 million was allocated to study EMS planning, operations, expansion, and research. Continued funding for regional systems until ’81. USA

To be eligible for funding a system must address: MANPOWER TRAINING COMMUNICATIONS CRITICAL CARE UNITS PUBLIC SAFETY AGENCIES CONSUMER PARTICIPATION TRANSPORTATION ACCESS TO CARE DISASTER PLANS EMERGENCY FACILITIES PATIENT TRANSFER MUTUAL AID STANDARDIZED RECORDKEEPING PUBLIC INFORMATION & EDUCATION SYSTEM REVIEW & EVALUATION Shows how involved an EMS system is and that all parts must be in place for funding and a good system.

Two Items the Legislation Omitted System finance Medical direction And medical direction is such an integral part of the system today

1975 Ontario had developed EMCA system Ambulance and Emergency Care college course (AEC)- a one year program First certifications were in 1976 Initial college course was 1 year long.

1977 Air Ambulance System started

“Star of Life” “Just as pharmacists have the mortar and pestle and doctors have the caduceus, Paramedics and Emergency Medical Responders have a symbol in the ‘Star of Life.’”

“Star of Life” Designed by Leo R. Schwartz, Chief of the EMS Branch, National Highway Traffic Safety Administration (NHTSA), the "Star of Life" was created after the American National Red Cross complained in 1973 that they objected to the common use of an Omaha orange cross on a square background of reflectorized white which clearly imitated the Red Cross symbol.

“Star of Life” The newly designed, six barred cross, was adapted from the Medical Identification Symbol of the American Medical Association registered on February 1, 1977 Each of the bars of the blue "Star of Life" represents the six system function of the EMS.

“Star of Life” The snake and staff in the center of the symbol portray the staff of Asclepias, who, according to Greek mythology, was the son of Apollo . Asclepias was usually shown in a standing position, dressed in a long clock, holding a staff with a serpent coiled around it. The snake and staff in the center of the symbol portray the staff Asclepias who, according to Greek mythology, was the son of Apollo (god of light, truth and prophecy). Supposedly Asclepias learned the art of healing from the centaur Cheron; but Zeus - king of the gods, was fearful that because of the Asclepias knowledge, all men might be rendered immortal. Rather than have this occur, Zeus slew Asclepias with a thunderbolt. Later, Asclepias was worshiped as a god and people slept in his temples, as it was rumored that he effected cures of prescribed remedies to the sick during their dreams. Asclepias was usually shown in a standing position, dressed in a long clock, holding a staff with a serpent coiled around it. The staff has since come to represent medicine's only symbol. In the Caduceus, used by physicians and the Military Medical Corp., the staff is winged and has two serpents intertwined. Even though this does not hold any medical relevance in origin, it represents the magic wand of the Greek diety, Hermes, messenger of the gods.

“Star of Life” The Bars in the Star of life represent the Six System Function of the EMS. Detection Reporting Response On Scene Care Care In Transit Transfer to Definitive Care

1960/70s Dr Norman McNally Standardized system for ambulances and attendants 1972 First Ambulance and Emergency Care course starts at Humber College with 25 students.

1981 …the passage of the Consolidated Omnibus Budget Reconciliation Act (COBRA) wiped out federal EMS funding. Canadian Provinces starting to look at Paramedic Programs Ontario Pilot Program 1984 – For ACPS EMA’s (level I to III) BC, Sask, Manitoba, Ontario provided Paramedic education. In Canada they were called EMA’s

1988-Components of an EMS system Communications Trauma Systems Public Information Medical Direction Evaluation Regulation Resources Management Human Resources/Training Transportation Facilities * 10 system elements necessary for an EMS system. Although not formally adopted by Canadian EMS systems, they are often referred to.

Modern Trends Within the last 10 years, moved from a variety of “Ambulance Services”, operated by: Privately Managed Hospitals Fire Services and Municipal Governments To more true EMS Systems Toronto did it back in the 1970’s but it has taken longer in the rest of the province.

1990’s OPALS-Ontario Advanced Life Support Study (Dr. Steele)-Ottawa Stiell IG, Wells GA, De Maio VJ, Nesbitt L et al. Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest. N Engl J Med 2004; 351:647-656. Two separate streams Cardiac Arrest Critical Care SR/Defib PCP version of above Not a study

2000’s 2000 – Colleges change to 2 year PCP program EMCA exam – changed to Advanced EMCA to account for SR/Defib content Downloading of ambulance services to UTM’s from other source (MOH, private or cities) Technology advances. Computers on board ambulances, advanced airways, more meds, monitoring 2004 –Stroke bypass (various regions) 2007 + PTCA bypasses (Ottawa, York, TO, LDN) 2009 Revision of DNR, Combining of BH groups 2011 Change in ALS standards, BLS standards Deceased pt standard, 2012 PTBO regional considering STEMI bypass for EMS